Comparison of Efficacy and Safety in Sublay versus Onlay Mesh Repair for Para-Umbilical Hernia: A Randomized Controlled Trial

Abstract

Background: Ventral hernias, either spontaneous or post-surgical, represent a significant challenge in surgical practice. The recurrence rates after primary tissue repair, especially in larger hernias, necessitate the use of tension-free mesh repairs. However, the choice between onlay and sublay mesh repair methods remains a subject of debate, with each technique having its own set of advantages and drawbacks. Objective: The study aimed to compare the efficacy and safety of sublay versus onlay mesh repair techniques in the treatment of ventral hernias, with a focus on postoperative complications, pain, and treatment success rates. Methods: This randomized controlled trial was conducted from May 2023 to October 2023 at multiple surgical centers. It involved 120 patients, aged 18 to 70 years, undergoing ventral hernia repair. Patients were randomly allocated into two groups: Group A (60 patients) receiving onlay mesh repair and Group B (60 patients) receiving sublay mesh repair. The study assessed postoperative complications, including seroma, wound infection, and pain using the Visual Analogue Scale (VAS), as well as overall treatment efficacy. Data were analyzed using SPSS version 25.0, with a p-value of less than 0.05 considered statistically significant. Results: The mean age in Group A was 40.90±11.56 years, and in Group B, 40.55±11.63 years. Group A comprised 41.7% males and 58.3% females, while Group B had 46.7% males and 53.3% females. In Group A, seroma developed in 10%, wound infection in 15%, and postoperative pain in 18.3% of patients. Group B reported seroma in 3.3%, wound infection in 3.3%, and postoperative pain in 6.7%. The effectiveness of the treatment was 80% in Group A and 93.3% in Group B, with a notable difference in complication rates and success between the groups. Conclusion: The sublay mesh repair technique demonstrated superior outcomes in terms of lower complication rates and higher treatment efficacy compared to the onlay method. This suggests that the sublay approach may be more advantageous for ventral hernia repair, offering better patient outcomes with fewer postoperative complications.